Eliminating Iodine Deficiency in China: Achievements, Challenges and Global Implications

Dianjun Sun, Karen Codling, Suying Chang, Shubin Zhang, Hongmei Shen, Xiaohui Su, Zupei Chen, Robert W Scherpbier, Jun Yan, Dianjun Sun, Karen Codling, Suying Chang, Shubin Zhang, Hongmei Shen, Xiaohui Su, Zupei Chen, Robert W Scherpbier, Jun Yan

Abstract

The prevention of iodine deficiency through salt iodization has been recognized as a global success story, and China stands at the forefront of this achievement with one of the most successful programs in the world. High level political commitment, national mandatory legislation, a state-managed edible salt industry and a complex and highly sophisticated surveillance system have facilitated the success of the program. Challenges have arisen however, including: (i) concern that adequate iodine status in pregnant women cannot be achieved without causing above adequate iodine intakes in children; (ii) declining iodine intake as a result of reductions in salt consumption and increased consumption of processed foods, which may not be made with iodized salt; (iii) the existence of areas with high iodine content in the water; and (iv) declines in household use of iodized salt due to concerns about excess iodine intake and thyroid disease. This article reviews the achievements and challenges of the Chinese Iodine Deficiency Disorders (IDD) Elimination Program and reflects on lessons learned and implications for other national salt iodization programs.

Keywords: China; iodine deficiency; iodine status; salt iodization.

Conflict of interest statement

The authors declare no conflict of interest. The findings and conclusions of this report are those of the authors and do not necessarily represent the official position of the National Health and Family Planning Commission of China, UNICEF or the Iodine Global Network.

Figures

Figure 1
Figure 1
Sources of dietary sodium in China, 1991–2009 [58].

References

    1. World Health Organization. The United Nations Children’s Fund. The International Council for Control of Iodine Deficiency Disorders . Assessment of Iodine Deficiency Disorders and Monitoring Their Elimination: A Guide for Programme Managers. 2nd ed. World Health Organization; Geneva, Switzerland: 2007.
    1. Delange F. The disorders induced by thyroid deficiency. Thyroid. 1994;4:107–128. doi: 10.1089/thy.1994.4.107.
    1. Zimmerman M.B., Jooste P.J., Pandav C.S. Iodine deficiency disorders. Lancet. 2008;372:1251–1262. doi: 10.1016/S0140-6736(08)61005-3.
    1. World Health Organization Micronutrient Deficiencies: Iodine Deficiency Disorders. [(accessed on 1 February 2017)]; Available online:
    1. Qian M., Wang D., Watkins W., Gebski V., Yan Y.Q., Li M., Chen Z. The effects of iodine on intelligence in children: A meta-analysis of studies conducted in China. Asia Pac. J. Clin. Nutr. 2005;14:32–42.
    1. Hynes K.L., Otahal P., Hay I., Burgess J. Mild iodine deficiency during pregnancy is associated with reduction educational outcomes in the offspring: 9-year follow-up of the gestational iodine cohort. J. Clin. Endocrinol. Metab. 2013;98:1954–1962. doi: 10.1210/jc.2012-4249.
    1. Bath S.C., Steer C.D., Golding J., Emmett P., Rayman M.P. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: Results from Avon Longitudinal Study of Parents and Children (ALSPC) Lancet. 2013;382:331–337. doi: 10.1016/S0140-6736(13)60436-5.
    1. Universal Salt Iodization: Global Progress and Public Health Success Stories to Address IDD through USI, Key Programme Components, Lessons Learned at Country Level, and the Way Forward to Reach USI Globally. [(accessed on 1 February 2017)]; Available online: .
    1. Laurberg P., Bulow Pedersen I. Environmental iodine intake affects the nonmalignant thyroid disease. Thyroid. 2001;11:457–469. doi: 10.1089/105072501300176417.
    1. World Health Organization (WHO) Guideline: Fortification of Food-Grade Salt with Iodine for the Prevention and Control of Iodine Deficiency Disorders. World Health Organization; Geneva, Switzerland: 2014.
    1. UNICEF Fortifying our Future: A Snapshot Report on Food Fortification. [(accessed on 1 February 2017)];2015 Sep; Available online: .
    1. Iodine Global Network Legislation Database. [(accessed on 30 January 2017)]; Available online: .
    1. UNICEF State of the World’s Children 2015. [(accessed on 1 February 2017)]; Available online: .
    1. Iodine Global Network Global Scorecard 2016: Moving toward Optimal Iodine Status. [(accessed on 1 February 2017)]; Available online: .
    1. Abuto N.J., Abudou M., Candeias V., Wu T. Effect and Safety of Salt Iodization to Prevent Iodine Deficiency Disorders: A Systematic Review with Meta-Analysis. World Health Organization; Geneva, Switzerland: 2014. WHO eLibrary of Evidence for Nutrition Actions.
    1. Horton S., Mannar V., Wesley A. Best Practice Paper: Micronutrient Fortification (Iron and Salt Iodization) Copenhagen Consensus; Copenhagen, Denmark: 2008.
    1. Wang J., Harris M., Amos B., Li M., Wang X., Zhang J., Chen J. A ten year review of the Iodine Deficiency Disorders Program of the People’s Republic of China. J. Public Health Policy. 1997;18:219–241. doi: 10.2307/3343436.
    1. Yan Y. Survey on iodine nutritional status of school-aged children in 10 cities in China. Chin. J. Control Endem. Dis. 1995;10:326–329.
    1. Chen Z., Dong Z., Lin J. Achieving, and sustaining USI: Effective program development and management. Lessons learned from USI in China. SCN News. 2007;35:33–36.
    1. Wang L., Qi X., Bai H., Sun D. Meet the Challenge (To Commemorate the 10th Anniversary of Universal Salt Iodization, 1996–2006) Bureau of Disease Prevention and Control, Ministry of Health, People’ Republic of China; Beijing, China: 2006.
    1. The United Nations Children's Fund . Review of National Legislation for Universal Salt Iodization: South and East Asia and the Pacific. UNICEF East Asia and Pacific Regional Office; Geneva, Switzerland: 2015.
    1. Zheng Q., Xu J., Dong H., Wang H., Li S., Chen Z. China IDD surveillance system and its role in the prevention and control of IDDs. Chin. J. Dis. Control Prev. 2010;25:428–430. (In Chinese)
    1. The Chinese Center for Disease Control and Prevention . Assessment Scheme for the Stage Goal Achievement of IDD Elimination (No. 58) CCDC; Beijing, China: 1999. (In Chinese)
    1. The State Council of the People’s Republic of China . Control Iodized Salt Management Regulations for IDD (No. 163) SCPRC; Beijing, China: 1994. (In Chinese)
    1. The State Council of the People’s Republic of China . The Salt Industry Management Regulations of the People’s Republic of China (No. 51) SCPRC; Beijing, China: 1990. (In Chinese)
    1. World Bank Operations Evaluation Department . An Analysis of Combating Iodine Deficiency: Case Studies of China, Indonesia, and Madagascar. The World Bank; Washington, DC, USA: 2001. (OED Working Paper Series No. 18).
    1. Ministry of Health GB14880-94 Hygienic Standard for the Use of Nutritional Fortification Substances in Foods. [(accessed on 29 March 2017)]; Available online: .
    1. Duan D., Chen J., Li Z., Xu H. China IDD Surveillance in 1995. People’s Medical Publishing House; Beijing, China: Jul, 1999. (In Chinese)
    1. Ministry of Health . GB 4561-2000 Edible Salt National Standards. National Environmental Protection Bureau; Beijing, China:
    1. Ministry of Health GB 26878-2011: National Standard on Food Safety—Iodine Content of Edible Salt. [(accessed on 1 February 2017)]; Available online:
    1. Sun D., Xiao D., Liu S. The Monitoring of Iodine Deficiency Disorders of China in 2011. People’s Medical Publishing House; Beijing, China: 2011.
    1. Codling K., Rudert C. IDD Newsletter; [(accessed on 1 February 2017)]. Putting East Asia Back on Track towards Sustainable USI. Available online: .
    1. 735 Villages and Towns of 109 Counties Are High Water Iodine Areas in China. [(accessed on 1 February 2017)]; Available online: . (In Chinese)
    1. General Office of the Ministry of Health. General Office of the Ministry of Industry and Information Technology. The Chinese Center for Disease Control and Prevention . Notice on Further to Do Non-Iodized Salt Supply and Management Better (No.168) GOMH; GOMIIT; CCDC; Beijing, China: 2009. (In Chinese)
    1. Liu P., Liu L., Shen H., Jia Q., Wang J., Zheng H., Ma J., Zhou D., Liu S., Su X. The standard intervention measures and health risk for high water iodine areas. PLoS ONE. 2014;9:e89608. doi: 10.1371/journal.pone.0089608.
    1. Li Q., Su X., Yu J., Zhang S., Liu P., Ji X., Liu S., Sun D. Analysis of field survey results for iodine deficiency disorders in high-risk areas of China. Chin. J. Endemiol. 2009;2:197–201. (In Chinese)
    1. Wu Y., Li X., Chang S., Liu L., Zou S., Hipgrave D. Variable iodine intake persists in the context of universal salt iodization in China. J. Nutr. 2012 doi: 10.3945/jn.112.157982.
    1. Pandav C., Yadav K., Lakshmy R., Pandey R.M., Salve H.R., Chakrabarty A., Knowles J., Sankar S., Rah J.H., Ansari M.A. Across India, Women Are Iodine Sufficient. [(accessed on 1 February 2017)]; Excerpt from National Iodine and Salt Intake Survey (NISI) 2014–2015: Executive Summary. Available online: .
    1. The World Bank . Repositioning Nutrition as Central to Development: A Strategy for Large Scale Action. The World Bank; Washington, DC, USA: 2006.
    1. The World Bank Memorandum and Recommendation of the President of the International Bank for Reconstruction and Development and the International Development Association to the Executive Directors on a Proposed Loan in an Amount Equivalent to $7.0 Million and a Proposed Credit of SDR 12.7 Million to the People’s Republic of China for an Iodine Deficiency Disorders Control Project. [(accessed on 1 February 2017)];1995 Jun 6; Available online: .
    1. Chang S. (United Nations Children’s Fund, Beijing, China). Personal communication. 2017.
    1. Sun D., Shen H. National Key Endemic Disease Monitoring (1990–2006) Beijing People’s Medical Publishing House; Beijing, China: 2009. pp. 118–144. (In Chinese)
    1. Shen H. China iodine deficiency or excess hazard prevention and control situation and the countermeasures. Chin. J. Endemiol. 2012;31:239–240. (In Chinese)
    1. Sun D.J. (Centre for Endemic Disease Control, Heilongjiang, China). Personal commuication. 2017.
    1. World Health Organization (WHO) Urinary Iodine Concentrations for Determining Iodine Status Deficiency in Populations. Vitamin and Mineral Nutrition Information System. World Health Organization; Geneva, Switzerland: 2013.
    1. Zimmermann M.B., Aeberli I., Andersson M., Assey V., Yorg J.A., Jooste P., Jukić T., Kartono D., Kusić Z., Pretell E., et al. Thyroglobulin is a sensitive measure of both deficient and excess iodine intakes in children and indicates no adverse effects on thyroid function in the UIC range of 100–299 μg/L: A UNICEF/ICCIDD Study Group report. J. Clin. Endocrinol. Metab. 2013;98:1271–1280. doi: 10.1210/jc.2012-3952.
    1. Suzuki H., Higuchi T., Sawa K., Ohtaki S., Horiuchi Y. “Endemic coast goitre” in Hokkaido, Japan. Acta Endocrinol. 1965;50:161–176. doi: 10.1530/acta.0.0500161.
    1. Li M., Liu D.R., Qu C.Y., Zhang P.Y., Qian Q.D., Zhang C.D., Jia Q.Z., Wang H.X., Eastman C.J., Boyages S.C. Endemic goitre in central China caused by excessive iodine intake. Lancet. 1987;2:257–259.
    1. Zhao J., Chen Z., Maberly G. Iodine-rich drinking water of natural origin in China. Lancet. 1998;352:2024. doi: 10.1016/S0140-6736(05)61375-X.
    1. Li W.H., Dong B.S., Li P., Li Y.F. Benefits and risks from the national strategy for improvement of iodine nutrition: A community-based epidemiologic survey in Chinese schoolchildren. Nutrition. 2012;28:1142–1145. doi: 10.1016/j.nut.2012.04.014.
    1. Zimmermann M.B., Ito Y., Hess S.Y., Fujieda K., Molinari L. High thyroid volume in children with excess dietary iodine intakes. Am. J. Clin. Nutr. 2005;81:840–844.
    1. Chen W., Li X., Wu Y., Bian J., Shen J., Jiang W., Tan L., Wang X., Wang W., Pearce E.N., et al. Associations between iodine intake, thyroid volume, and goiter rate in school-aged children from areas with high iodine drinking water concentrations. Am. J. Clin. Nutr. 2017;105:228–233. doi: 10.3945/ajcn.116.139725.
    1. World Health Organization (WHO) Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2 years: Conclusions and recommendations of the Technical Consultation. Public Health Nutr. 2007;10:1606–1611.
    1. Xu J., Wang J.-Q., Zheng Q.-S., Gu Y.-Y., Wang H.-Y., Li X.-W. Analysis of monitoring results of Chinese iodized salt surveillance in 2010. Chin. J. Endemiol. 2012;5:552–555. (In Chinese)
    1. Ghassabian A., Steenweg-de Graaff J., Peeters R.P., Ross H.A., Jaddoe V.W., Hofman A., VerHULST F.C., White T., Tiermeier H., et al. Maternal urinary iodine concentration in pregnancy and children’s cognition: Results from a population-based birth cohort in an iodine-sufficient area. BMJ Open. 2014;4:e005520. doi: 10.1136/bmjopen-2014-005520.
    1. Shi X., Han C., Li C., Mao J., Wang W., Xie X., Li C., Xu B., Meng T., Du J., et al. Optimal and safe upper limits of iodine intake for early pregnancy in iodine sufficient regions: A cross-sectional study of 7190 pregnant women in China. J. Clin. Endocrinol. Metab. 2014 doi: 10.1210/jc.2014-3704.
    1. Cui J. Investigation report on iodized salt in China’s food processing industry. Chin. Salt Indus. 2012;6:11–14.
    1. Du S., Batis C., Wang H., Zhang B., Zhang J., Popkin B.M. Understanding the patterns and trends of sodium intake, potassium intake and sodium to potassium ratio and their effect on hypertension in China. AJCN. 2014;99:334–343. doi: 10.3945/ajcn.113.059121.
    1. Hipgrave D., Chang S., Li X., Wu Y. Salt and sodium intake in China. JAMA. 2016;315:703–705. doi: 10.1001/jama.2015.15816.
    1. Shen H., Liu S., Sun D., Zhang S., Su X., Shen Y., Han H. Geographical distribution of drinking water with high iodine level and association between high iodine level in drinking water and goitre: A Chinese national investigation. Br. J. Nutr. 2011;106:243–247. doi: 10.1017/S0007114511000055.
    1. Zhao J., Wang P., Shang L., Sullivan K.M.F., Maberly G. Endemic goitre associated with high iodine intake. Am. J. Public Health. 2000;90:1633–1635.
    1. Lv S., Zhao J., Xu D., Rutherford S. An epidemiological survey of children’s iodine nutrition and goitre status in regions with mildly excess iodine in drinking water in Hebei province, China. Public Health Nutr. 2012;15:1168–1173. doi: 10.1017/S1368980012000146.
    1. Lv S., Xu D., Wang Y., Chong Z., Du Y., Jia L., Zhao J., Ma J. Goitre prevalence and epidemiological features in children living in areas with mildly excessive iodine in drinking water. Br. J. Nutr. 2014;11:86092. doi: 10.1017/S0007114513001906.
    1. Sui H., Li J.W., Mao W.F., Zhu J.H., He Y.N., Song Y., Ma N., Zhang L., Liu S.N., Liu P., et al. Dietary iodine intake in the Chinese population. Biomed. Environ. Sci. 2011;24:617–623.
    1. Liu H.L., Lam L.T., Zeng Q., Han S.Q., Fu G., Hou C.C. Effects of drinking water with high iodine concentration on the intelligence of children in Tianjin, China. J. Public Nutr. 2008;31:32–38. doi: 10.1093/pubmed/fdn097.
    1. Chen W., Sang Z., Tan L., Zhang S., Dong F., Chu Z., Wei W., Zhao N., Zhang G., Yao Z., et al. Neonatal thyroid function born to mothers living with long-term excessive iodine intake from drinking water. Clin. Endocrinol. 2015;83:399–404. doi: 10.1111/cen.12625.
    1. Lv S., Xu D., Wang Y., Jun Z., Jia L., Du Y. Impact of removing iodized salt on children’s goitre status in areas with excessive iodine in drinking water. Br. J. Nutr. 2015;113:114–119. doi: 10.1017/S0007114514003365.
    1. Hou C., Fu G., Zeng Q., Liu H. Studies on the effect of changing water in high water-iodine area in Tianjin. Chin. J. Control Endem. Dis. 2010;25:444–450. (In Chinese)
    1. Wang M., Li H., Wang M., Li J., Li X., Li J. Survey on the Residents’ Iodine Level in High Iodine Area after Taking Low Iodine Water in Shouguang City, 2009. Prev. Med. Tribune. 2010;16:1010–1011.
    1. Wang P., Zhang Q., Shang L., Fei Y., Liu C., Chen Y., Liang P. Children goiter rate change analysis before and after water source change in high water iodine area. Prim. Health Care. 2005;12:61–62. (In Chinese)
    1. National Standards of People’s Republic of China Standards for Drinking Water Quality. [(accessed on 1 February 2017)]; GB5749-2006. Available online: .
    1. Nima C., Gong H., Guo M., He F., Zhao S., Deji Y. Tibet autonomous region iodized salt monitoring result analysis in 2011–2013. Tibet. J. Med. 2014;4:44–45. (In Chinese)
    1. Wang F., Li X., Ma L., PA L., Yi L., Ye E., Gu L., Mai L, Hai X., Xu Y. Distribution of non-iodized salt and related affecting factors in Xinjiang. Chin. J. Epidemiol. 2002;23:258–261. (In Chinese)
    1. Wang Z., Li Y., Xiong C., Zhou Li. Qinghai province IDD prevention and treatment monitoring results and analysis in 1995. Bull. Dis. Control Prev. 1996;11:107–108. (In Chinese)
    1. Wang H., Su Y., Wu L., Yi C. Iodized salt monitoring result analysis of Hainan province in 2004–2011. Chin. J. Endemiol. 2013;32:284–287. (In Chinese)
    1. Teng W., Shan Z., Teng X., Guan H., Li Y., Teng D., Jin Y., Yu X., Fan C., Chong W., et al. Effect of iodine intake on thyroid diseases in China. NEJM. 2006;354:2783–2793. doi: 10.1056/NEJMoa054022.
    1. Yang F., Teng W., Shan Z., Guan H., Li Y., Jin Y., Hu F., Shi X., Tong Y., Chen W., et al. Epidemiological survey on the relationship between different iodine intakes and the prevalence of hyperthyroidism. Eur. J. Endocrinol. 2002;146:613–618. doi: 10.1530/eje.0.1460613.
    1. Teng X., Shan Z., Chen Y., Lai Y., Yu J., Shan L., Bai X., Li Y., Li N., Li Z., et al. More than adequate iodine intake may increase subclinical hypothyroidism and autoimmune thyroiditis: A cross sectional study based on two Chinese communities with different iodine intakes. Eur. J. Endocrinol. 2011;164:943–950. doi: 10.1530/EJE-10-1041.
    1. Shan Z., Chen L., Lian X., Liu C., Shi B., Shi L., Tong N., Wang S., Weng J., Zhao J., Teng X., et al. Iodine Status and Prevalence of Thyroid Disorders After Introduction of Mandatory Universal Salt Iodization for 16 Years in China: A Cross-Sectional Study in 10 Cities. Thyroid. 2016;26:1125–1130. doi: 10.1089/thy.2015.0613.
    1. Song X., Li F., Liu Z., He Y., Sui H., Mao W., Liu S., Yan Y., Li N., Chen J. Assessment of Dietary Iodine Intake of Population in Non High-Iodine Areas in China. [(accessesd on 1 February 2017)]; Available online: .
    1. Chen J. The Assessment of iodine status in Chinese residents; Proceedings of the 2016 Iodine and Thyroid Disease Conference; Harbin, China. 19–20 October 2016.
    1. Pearce E. Can USI achieve optimal iodine in all population groups: Preliminary results of SIMPLIFY: Salt Iodization: Meeting the needs of Pregnancy, Lactation and InFancY. A joint ETH/GAIN/UNICEF study; Proceedings of the 2016 Iodine and Thyroid Disease Conference; Harbin, China. 19–20 October 2016.
    1. Sang Z., Peizhong P. Exploration of the safe upper level of iodine intake in euthryroid Chinese adults: A randomized double-blind trial. Am. J. Clin. Nutr. 2011 doi: 10.3945/ajcn.111.028001.
    1. Ares S., Saenz-Rico B., Quero J., Morreale de Escobar G. Chapter 30. Iodine and the effects on growth in premature newborns: A focus on the role of thyroid hormones in neurodevelopment and growth. In: Preedy V.R., editor. Handbook of Growth and Growth Monitoring in Health and Disease. Springer Science & Business Media; New York, NY, USA: 2012.
    1. Khan N. Elimination of Iodine Deficiency in FIJI. [(accessed on 1 February 2017)];IDD Newsletter. 2009 Nov; Available online: .
    1. Health Research Institute. Ministry of Health Basic Health Research (RISKESDAS) 2013. [(accessed on 1 February 2017)]; Available online: .
    1. Mongolia Ministry of Health Fourth National Nutrition Survey 2010 (Nutritional Status of Mongolian Population) [(accessed on 29 March 2017)]; Available online:
    1. Australia Institute of Health and Welfare Monitoring the Health Impacts of Mandatory Folic Acid and Iodine Fortification. [(accessed on 1 February 2017)];2016 Available online: .
    1. Skeaff S., Lonsdale-Cooper E. Mandatory fortification of bread with iodized salt modestly improves iodine status in schoolchildren. BJN. 2013;109:1109–1113. doi: 10.1017/S0007114512003236.
    1. Brough L., Jin Y., Shukri N.H., Wharemate Z.R., Weber J.L., Coad J. Iodine intake and status during pregnancy and lactation before and after government initiatives to improve iodine status, in Palmerston North, New Zealand: A pilot study. Matern. Child Nutr. 2015;11:646–655. doi: 10.1111/mcn.12055.
    1. Philippines Food and Nutrition Research Institute National Nutrition Survey 2013. [(accessed on 1 February 2017)]; Available online: .
    1. Wong E.M., Sullivan K.M., Perrine C.G., Rogers L.M., Pena-Rosas J.P. Comparison of median urinary iodine concentrations as an indicator of iodine status among pregnant women, school-age children, and non-pregnant women. Food Nutr. Bull. 2011;32:206–213. doi: 10.1177/156482651103200304.
    1. Gorstein J. (University of Washington, Seattle, WA, USA), Zimmerman M. (Swiss Federal Insitue of Technoclogy (ETH), Zurich, Switzerland). Personal communication. Nov 5, 2014.
    1. Rogers L.M. WHO evidence and guidance for salt iodization & salt reduction; Proceedings of the Achieving Universal Salt Iodization for Optimal Iodine Nutrition in the East Asia and Pacific Region; Bangkok, Thailand. 12–14 October 2015.
    1. Chang S. (United Nations Children’s Fund, Beijing, China). Personal communication. 2016.
    1. Sun D.J. (Centre for Endemic Disease Control, Heilongjiang, China). Personal communication. 2016.
    1. National Health and Medical Research Council Public Statement. Iodine Supplementation for Pregnant and Breastfeeding Women. [(accessed on 1 February 2017)];2010 Jan; Available online: .
    1. Ministry of Health Iodine Question and Answers. [(accessed on 1 February 2017)]; Available online: .
    1. Alexander E.K., Pearce N.E., Brent G.A., Brown R.S., Chen H., Dosiou C., Grobman W.A, Lauberg P., Lazarus J.H., Mandel S.J., et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and Postpartum. Thyroid. 2016 doi: 10.1089/thy.2016.0457.
    1. Notifications of the Thai Ministry of Public Health . Royal Gazette Book 127, Special Part 115, 1 October, B.E.2553 (2010) on Fish Sauce, Saline Seasoning and Seasoning from Fermented Soy Protein. Ministry of Public Health; Nonthaburi, Thailand: 2010.
    1. Sangsom S. (Iodine Global Network, Bangkok, Thailand). Personal communication. 2015.
    1. Rajata R. (Ministry of Public Health, Nonthaburi, Thailand). Personal communication. 2015.
    1. Ministry of Health & National Agency of Drug and Food Control, Indonesia, Clarity & GAIN Usage of Iodized Salt in the Processed Food in Indonesia Industry. [(accessed on 29 March 2017)]; Available online: .
    1. Nutrition Centre of the Philippines for GAIN Survey of Food Processors Utilizing Iodized Salt and Salt Repackers. [(accessed on 3 April 2017)]; Available online: .
    1. The Health and Stroke Foundation. (South Africa). Salt is killing South Africans and It Is Time to Take Action. [(accessed on 1 February 2017)]; Available online: .
    1. American Heart Association Where Is All That Salt Coming From? [(accessed on 1 February 2017)]; Available online: .
    1. Ni Mhurchu C., Capelin C., Dunford E.K., Webster J.L., Neal B.C., Jebb S.A. Sodium content of processed foods in the United Kingdom: Analysis of 44,000 foods purchased by 21,000 households. AJCN. 2011;93:594–600. doi: 10.3945/ajcn.110.004481.
    1. Szybinski Z., Delange F., Lewinski A., Podoba J., Rybakowa M., Wasik R., Szewczyk L., Huszno B., Golkowski F., Przybylik-Mazurek E., et al. A program of iodine supplementation using only iodized household salt is efficient—the case of Poland. Eur. J. Endocrinol. 2001;144:331–337. doi: 10.1530/eje.0.1440331.
    1. Jayatissa R., Gunathilaka M. Third National Survey on Iodine Deficiency Status in Sri Lanka—2010. [(accessed on 3 April 2017)]; Available online: .
    1. Centre for Applied Health Technology and Clinical Epidemiology. Indonesia Ministry of Health. UNICEF Effect of Excess Iodine Intakes on Thyroid Function among School Children: Multicenter Study. [(accessed on 3 April 2017)]; Available online: .
    1. Kassim I.A., Moloney G., Busili A., Nur A.Y., Paron P., Jooste P., Gadain H., Seal A.J. Iodine intake in Somalia is excessive and associated with the source of household drinking water. J. Nutr. 2014;144:375–381. doi: 10.3945/jn.113.176693.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit